UCA K-12 Enrollment Application 2025-26

Student First Name

Student Middle Name

Student Last Name

Student Grade to Enter

Student Birthday

Date

Student - Male or Female

Student Age as of August 1 2024

Check here if Parent/Guardian information has been entered for a previous child

Parent/Guardian First & Middle Name

Parent/Guardian Last Name

Parent/Guardian Cell

Please enter a valid phone number.

Parent/Guardian Work

Please enter a valid phone number.

Parent/Guardian Email

example@example.com

Parent/Guardian Street address

City

State

Zip Code

Parent/Guardian First Name

Parent/Guardian Middle Name

Parent/Guardian Last Name

Parent/Guardian Cell

Please enter a valid phone number.

Parent/Guardain Work

Parent/Guardian Email

example@example.com

Parent/Guardian Street Address

City

State

Zip Code

Student's Religious Background

Current church attending

City & state

Church member

Regularly attending

Has student professed to have a personal relationship with Jesus Christ

Click here if Parent/Guardian information has been entered for a previous child

Current church attending

City/State

Church member

Regularly attending

Have student's parents (either or both) professed to have a personal relationship with Jesus

Have students parents either or both professed to have a personal relationship with Jesus Christ

Fathers name

Phone

Employer

Occupation

(married, widowed, single, divorced)

Mothers name

Phone Number

Please enter a valid phone number.

Employer

Occupation

Mother's marital status

If parents are unmarried separated or divorced who has custody of the child during the school year

If parents have joint or primarysecondary custody describe the terms of the custodial arrangement and provide the address of the jointsecondary parent

**If a court has issued an order regarding child custody, parents must provide a copy of the

Check here if Parent/Guardian information has been entered for a previous child

Primary emergency contact person

Relationship to student

Daytime phone

Secondary emergency contact person

Relationship to student

Daytime phone

Physician

Phone number

Medical conditions

Dentist

Phone number

Dental considerations (Braces, Brackets, et)

Name and address of students' current school or the school student last attended.

Administrator's name

Dates attended

Phone Number

Please enter a valid phone number.

Has your child ever been recommended for, referred to, or received behavioral or psychological counseling? If yes, explain

Has your child ever been arrested or charged with a civil infraction or a crime other than a traffic violation? If yes, explain

Has the student ever been suspended from, expelled from, or asked not to return to school for any reason? If yes, explain.

List any other factors in your childs life that would be helpful for the school to know absence or death of a parent traumatic incidentsaccidents etc

I hereby attest that the foregoing information about myself, my family, and my child is correct and may be fully relied upon by the school to determine whether my child may be accepted to United Christian Academy. I understand that my child will not be enrolled at United Christian Academy until I have been notified of his/her acceptance in writing by United Christian Academy and have completed the enrollment agreement and enrollment forms.

Custodial Parent/Guardian

Date

225 Crusader Court P.O. Box 486 Stanardsville, VA 22973

First

Middle

Last

Grade to enter

Names of parent or legal guardian

Statement of Understanding and Agreement

We, the undersigned, enroll Academy ("School") for the 2025-26 school year In consideration of School's acceptance of this agreement and enrollment of Student, we the undersigned agree jointly and severally to the following terms and conditions set forth in the remainder of this document.

"Student"

("Student") at United Christian

I have read and agree to be bound by the following financial conditions in consideration of the acceptance of this enrollment agreement with School:

1.I agree to be responsible for the financial obligations attendant to Student's enrollment at School including tuition and fees, (less any financial aid or early enrollment incentive) subject to the remaining provisions in this section. 2. The monetary amounts listed in the "fees" section above are non-refundable. 3. Transcripts and records will not be released to parents or schools until all outstanding balances have been paid in full. 4. Tuition payments made in accordance with the monthly payment plan are due on the 1st of each month (August-May A $15.00 fee will be assessed to late payments on each student's account that are not paid by the 10th of each month. 5. If Student's account is 30 days overdue, Student's parents or guardians will be required to meet with Mr. Lauer to discuss the ability to make up the late payment(s 6. If Student's account is 60 days overdue, Student will be suspended from further attendance at School until his or her account is brought up to date. 7.Returned checks will be assessed a $50.00 penalty which will be added to Student's account balance. 8. Tuition will continue to accrue throughout Student's suspension as long as Student is still enrolled.

9. Upon the withdrawal or expulsion of Student, tuition must be paid through the end of the same month as Student's last day. The amount of any previously applied tuition discounts will be reinstated to the total of Student's account upon the early withdrawal or expulsion of Student. This policy provides the School with time to try to fill the vacancy in enrollment. Payment will be prorated based on a 10-month payment plan, beginning with the month of August. Example: If John's parents withdraw him or he is expelled on January 4, they will owe tuition for John through January 31. If tuition is $5,000 per year, John's parents will owe tuition for 6 months (August-January), at $500 per month ($5,000 a year, divided by 10 months), for a total of $3,000. If John's last day is January 24, John's parents will owe tuition through the end of January plus whatever additional fee the school sets.

Tuition Discounts: 2 children - 7%, 3 children -12%, 4 children 15.5%

Please complete the records request form here: https://www.jotform.com/sign/240995936537069/invite/01hv22rth38b9e536cd11bacf2

I understand that my child and I have no expectation of privacy in any item that is Ministry-owned, including but not limited to any electronic devices or online services, and agree that Ministry authorities have the right to conduct random inspections of any Ministry-owned items to protect student and staff health, safety, and welfare. In addition, in the event the Ministry has reasonable grounds to believe my child possesses an unapproved item or has used a personal or Ministry-owned item in a manner that violates Ministry policy or any laws or regulations, the Ministry reserves the right to conduct a search of my child's pockets, bags, outerwear, shoes, electronic devices, any other item belonging to or in the possession of my child, or any online platform, account, or otherwise my child may have accessed. I understand that unless the situation potentially constitutes an emergency, the Ministry will first attempt to notify me if a search is necessary and will have two or more staff present for a search; however, my signature on this document constitutes my and my child's consent to conduct random and for-cause searches without additional or further consent when deemed necessary by Ministry officials. This consent extends to all Ministry activities, either at or away from the Ministry's campus.

I have read and agree with the following statement:

The staff desires a harmonious relationship with parents. If parents have a question about a School policy or an event that involves Student, they are to notify Student's teacher or the administration, where appropriate. An effort will be made to resolve any differences and maintain excellent communication between parents and School staff.

Parental support is an essential part of the educational process. If, in the sole discretion of the administration, a parent has failed to support the School staff or policies and procedures, including the code of conduct which is based on the statement of faith, or is disruptive to the academic, social, or spiritual environment of the school, the administration reserves the right to deny Student continued enrollment in School.

Elementary Handbook - Middle School & High School Handbook -

I have read and agree to be bound by the following statement: I have received a copy of the student handbook and a copy of the Ministry's statement of faith. I understand that it is my responsibility to read and understand these documents and to explain them to my child. I agree to abide by the provisions in the handbook applicable to parents and that my child and I will be held accountable for the policies and procedures contained therein, including the parental support statement, binding arbitration, and the code of conduct, all of which are based on the statement of faith. I agree that if, at any time during or away from school, my child violates any provisions of the code of conduct or any other provisions of the handbook, he or she will be subject to the discipline described in the handbook, up to and including suspension or expulsion from school. However, I also understand that enrollment in the school is a privilege and not a right and that my child's enrollment may be terminated at any time if, in the sole discretion of the administration, my (as parent or legal guardian) or my child's actions or attitudes are disruptive to or not compatible with the ministry's objectives, policies, philosophies, or otherwise. I understand that I am responsible for making all tuition payments and that my child's school records and transcript may be withheld until such payments are complete.

I have read and agree to be bound by the following statement: I agree that I will never make demands, threaten to sue, or actually litigate any matter whatsoever relating to or resulting from Student's enrollment at School. I understand that making demands, threatening to sue, or actually litigating a matter against School violates biblical teaching and practice and shall constitute sufficient grounds for immediate suspension or expulsion of Student's enrollment. The parties expressly waive their right to file a lawsuit against one another in any civil court for such disputes, except to enforce a legally binding arbitration decision.

Assumption of Risk and Liability Release

By signing below, I indicate that I have the understanding and capacity to make this agreement and that I am fully informed as to and understand the contents of this document.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED WITH ENROLLMENT OF STUDENT AT SCHOOL. I DO HEREBY AGREE

TO INDEMNIFY AND HOLD HARMLESS School and its agents and employees, and their heirs and assigns, from any and all past, present, future known and unknown liabilities, actions, causes of actions, claims, expenses, and damages, INCLUDING THOSE CAUSED BY

Signature

THE NEGLIGENCE OR FAULT OF THE SCHOOL, ITS LEADERS, EMPLOYEES, OR

VOLUNTEERS, and including without limitation, interest, penalties, court costs, attorney's fees, and expenses on account of injury to myself, my child, or my property which I now have or which may arise in the future in connection with Student's enrollment at School which is not the result of gross negligence, intentional neglect, or willful or wanton conduct by the School or its agents, representatives, or employees. I FURTHER RELEASE any and all claims brought by or through me, including claims for loss of consortium and all similar claims based on relationships with other people. I EXPRESSLY AGREE that this release, waiver,and indemnity agreement is intended to be as broad and inclusive as permitted in the Stateof Virginia and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I ALSO AGREE that any controversy or claim, by or through the party signing this release, arising out of or relating to the activities anticipated by this form shall be settled by binding Christian arbitration conducted by the National Center for Life and Liberty or another Christian arbitrator, and judgment on the award may be entered in any court having jurisdiction thereof. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not mere recitals. I further state that I have carefully read the foregoing information and know the contents thereof, and I sign this document as my own free act. This is a legally binding agreement which I have read and understand.

Do you as parent/guardian have reason to suspect a reading or learning disability.

Has your child ever been diagnosed with special needs?

School Phone Number

Date

Signature

Date

Custodial ParentGuardian

Date

Date agreement recd

Date

Signature

Date enrollment fees paid

Date

Date Immunization records recd

Date

Date testingprevious school records recd

Date

225 Crusader Court P.O. Box 486 Stanardsville, VA 22973

Name of Previous School

Students Full Name

Date of Birth

Date

Grade

Please send the following applicable student information: o Transcript or report cards (credited, non-credited courses and GPA) List of courses and grades at the time of withdrawal

Test data/ standardized test scores Attendance Records

Health & Immunization Records (Complete Physical & Vaccine Records) Discipline Records Special Education Records (IEP, 504 Plan, Psychological and/or psychiatric evaluations, Current Social History, and Educational Evaluations)

Additional Information

I give my permission to send the complete records of my child(ren) to:

UNITED CHRISTIAN ACADEMY P.O. BOX 486

Email: Admissions@ucacrusaders.com

Print ParentGuardian

Date Requested

Date

Signature ParentGuardian

UNITED CHRISTIAN ACADEMY

UNITED CHRISTIAN ACADEMY

UNITED CHRISTIAN ACADEMY

RECORDS REQUEST FORM

STANARDSVILLE, VA 22973